Dog bitesBMJ 2007; 334 doi: https://doi.org/10.1136/bmj.39105.659919.BE (Published 22 February 2007) Cite this as: BMJ 2007;334:413
- Marina Morgan, consultant medical microbiologist1,
- John Palmer, consultant plastic and reconstructive surgeon2
- 1Old Pathology Laboratory, Royal Devon and Exeter Foundation Trust, Exeter EX2 5AD
- 2Department of Plastic and Reconstructive Surgery, Royal Devon and Exeter Foundation Trust, Exeter
- Correspondence to: M Morgan
Bites and maulings by dogs, sometimes fatal, are a worldwide problem and particularly affect children. Every year 250 000 people who have been bitten by dogs attend minor injuries and emergency units in the United Kingdom,1 and some of them are admitted to hospital for surgical debridement or intravenous antibiotics.
Wound management is as important as use of antimicrobials in preventing infection
Primary closure should be avoided in limb injuries where possible because of increased risk of infection
For patients considered to be at higher risk of infection, the prophylaxis of choice is co-amoxiclav
Erythromycin or flucloxacillin should never be used alone prophylactically as Pasteurella infection is usually resistant
Infected wounds presenting within 12 hours of injury are usually due to Pasteurella multocida
Patients at particularly high risk of infection are immunosuppressed patients, particularly those with asplenia or cirrhosis or those who have had a mastectomy
Increasingly, dog bites are the subject of litigation because bite wounds are still being sutured when they should be left open and because of incorrect antimicrobial prophylaxis.
The “hole and tear” effect—whereby canine teeth anchor the person while other teeth bite, shear, and tear the tissues—results in stretch lacerations, easily piercing immature cranial bones. The biting force of canine jaws varies with the breed, from 310 kPa to nearly 31 790 kPa in specially trained attack dogs.w1 w2 Large wounds, significant devitalisation, and high mortality can result, with the highest mortality in neonates (six times that in toddlers), who are usually bitten by household pets.23
This review is aimed at clinicians who deal with dog bites. The basic principles of wound management and indications for use of antimicrobials and rabies prophylaxis apply to clinicians in all countries, but the primary focus of this article will be the UK.
Overall, the clinical approach …